Heart bypass surgery through small incisions between the ribs.
The robotic coronary bypass program at NewYork-Presbyterian/Columbia treats blockages of the heart's main artery without opening the breastbone. It works with interventional cardiology on hybrid procedures that pair a bypass with stents. Choose the version written for you.
For patients and families
What the operation is, who it is for, what recovery looks like, and how to be evaluated.
For physicians
Selection criteria, the hybrid revascularization pathway, how to refer, the technology, and the regional landscape.
Robotic Cardiac Surgery Program, NewYork-Presbyterian/Columbia: (212) 305-8312 or request an appointment online.
How robotic bypass surgery works
A coronary bypass gives blood a new route around a blocked artery. In the traditional operation the surgeon opens the breastbone. In robotic bypass surgery the surgeon works through two small incisions between the ribs on the left side of the chest, controlling the instruments from a console in the same room.Columbia Surgery
The bypass itself uses an artery from inside your chest wall, the internal mammary artery. The surgeon sews it to the left anterior descending artery (the LAD), the vessel that feeds most of the front wall of the heart. Traditional bypass surgery relies on the same graft; the robotic approach changes how the surgeon reaches it.
Why patients ask for it
Compared with opening the breastbone, the robotic approach means less pain, less bleeding, less scarring and a faster recovery.Columbia Surgery People go back to work and to normal life sooner, with the same graft surgeons have used for decades.
Who does the operation
The surgeon. The robot holds the instruments and reproduces the surgeon's hand movements with a magnified, high-resolution 3D view; it never moves on its own.Columbia Surgery Columbia's robotic cardiac surgery program began in 2023 and has passed its 300th robotic heart operation.Columbia MedicineColumbia Surgery
Robotic Cardiac Surgery Program, NewYork-Presbyterian/Columbia. Call, or use the online form; bring your most recent catheterization report if you have one.
Who is a candidate
Robotic bypass is designed for blockages in the LAD. Whether it fits you depends on where your blockages are, the shape of your chest, and your overall health. The evaluation answers that; below is what the team looks for.Columbia Surgery
- One blocked artery, the LAD
- The most common case. Robotic bypass gives you an arterial graft to the LAD without a sternotomy. That matters most for younger patients who want a repair that lasts longer than a stent.
- Several blocked arteries
- Two paths. The surgeon may graft more than one artery robotically using both internal mammary arteries. Or the team may recommend a hybrid plan: robotic bypass to the LAD, and stents for the other blockages placed by an interventional cardiologist. How the hybrid option works.
- Several blockages, with only the LAD territory left to protect
- When the heart muscle beyond the other blockages is scarred and would not recover, a single robotic graft to the LAD can be the whole operation.
When traditional bypass is the better operation
Some chests and some blockages are not suited to the robotic approach. The team asks about prior open heart surgery and unfavorable chest anatomy, and reviews your angiogram for arteries the robot cannot reach safely.Columbia Surgery In those cases the same surgeon performs traditional bypass surgery. Asking about the robot does not commit you to it; many patients who come in asking about it leave with a different plan that suits them better.
What the evaluation involves
- A review of your catheterization (angiogram) images, which show where the blockages are.
- An echocardiogram, an ultrasound of the heart.Columbia Surgery
- Sometimes a CT scan of the chest, to map the arteries and the chest wall.Columbia Surgery
- Preadmission testing: blood work, chest x-ray, EKG and urine tests, with no fasting required for the blood work.Columbia Surgery
One robotic bypass plus stents
Hybrid coronary revascularization treats several blockages with two smaller procedures instead of one large operation. The surgeon grafts the LAD robotically, and an interventional cardiologist opens the other blockages with stents.J Clin Med 2025
Why combine them
The surgical graft to the LAD is the part of bypass surgery with the strongest long-term record, and modern stents work well in the other arteries. Doing both avoids opening the breastbone and lets the bypass be done on the beating heart, without the heart-lung machine.J Clin Med 2025
How it is scheduled
Most centers do the two procedures in stages, from a few days to a few weeks apart, in the order your heart team chooses. Surgery usually comes first when the LAD blockage is the most urgent one.J Clin Med 2025
What the randomized trials found
Two randomized trials compared hybrid revascularization with traditional multi-vessel bypass. Rates of death, heart attack, stroke and repeat procedures were similar, at 2 years in one trial and 5 years in the other, and hospital stays were shorter with the hybrid approach.J Clin Med 2025
What it means for you
- Two procedure days instead of one long operation.
- Blood-thinning medicines (antiplatelet drugs) after the stents, for as long as your cardiologist advises.
- One plan, agreed by your surgeon and your cardiologist together, and your own cardiologist stays in charge of your follow-up.
What to expect, before and after
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Before surgery
You meet the team, who review your symptoms, prior surgeries and medications, and decide which medicines to hold. You have an echocardiogram if you have not had one, plus blood work, a chest x-ray, an EKG and a urine test.Columbia Surgery
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The operation
General anesthesia. Two small incisions between the ribs on the left side of the chest. The surgeon frees the internal mammary artery from the chest wall with the robot. It is then sewn to the LAD, usually on the beating heart, with a small stabilizer holding the artery still.Columbia SurgeryAnn Cardiothorac Surg 2024
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The first day
Most patients spend the first night in the intensive care unit and move to a regular room the next day.Columbia Surgery
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Going home
Typically 2 to 4 days after surgery.Columbia Surgery
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Back to normal
Work, driving and heavy lifting at about 2 weeks; normal activity within 2 to 3 weeks.Columbia Surgery
Risks
Like any heart operation, robotic bypass carries risks of bleeding, infection, stroke and irregular heart rhythm. Columbia's surgical team reports that these risks are lower with a robot-assisted or minimally invasive operation than with traditional open-heart surgery.Columbia Surgery
Insurance
Robotic bypass surgery is covered by insurance in the same way as other bypass surgery.Columbia Surgery The office confirms your plan before scheduling.
Follow-up
You see the surgical team after discharge, and your own cardiologist continues your care. If you had stents as part of a hybrid plan, your cardiologist manages the antiplatelet medicines.
Questions patients ask
Is robotic surgery as safe as open surgery?
"In the hands of an expert and experienced cardiac surgeon, it is as safe as traditional heart surgery performed through a sternotomy."
Columbia Surgery, Guide to Robotic Heart SurgeryColumbia Surgery
How long does the operation take?
Robotic heart operations at Columbia typically take 3 to 4 hours in the operating room. The breathing tube usually comes out in the operating room or shortly after you reach the intensive care unit.Columbia Surgery
What will the scars look like?
Small marks on the left side of the chest, between the ribs, where the instruments went in. There is no incision down the middle of the chest.Columbia Surgery
I have more than one blockage. Does that rule me out?
No. Multi-vessel disease can be treated with more than one robotic graft, or with the hybrid approach that combines a robotic bypass with stents. Read about the hybrid option.
What if I am not a candidate?
The same surgeon performs traditional bypass surgery, and the evaluation tells you which operation fits your anatomy.
Does insurance cover it?
Yes.Columbia Surgery The office verifies your specific plan.
What should I bring to the first visit?
- Your catheterization report, and the images on a disc or an image-sharing link if you have them.
- Any echocardiogram or stress test results.
- A list of your medicines, including blood thinners.
- Records of any prior chest or heart surgery.
Does my surgeon control the robot, or does it decide anything on its own?
Your surgeon controls it entirely, seated at a console a few feet from you, moving instruments inside your chest in real time. The robot has no ability to act independently or make decisions during your operation.Columbia Surgery
Which robot does Columbia use, and does the brand matter?
Columbia uses the da Vinci system, made by Intuitive Surgical. It is the same family of systems used in the first robot-assisted coronary bypass performed in the United States, at this hospital, in January 2002.CUIMC news Other companies, including Medtronic and Johnson & Johnson, make robots too, but for other kinds of surgery: joint and spine replacement, hernia repair, and gynecologic surgery. As of 2026, da Vinci is the only surgical robot the FDA has cleared for heart procedures, so most heart programs, including this one, use the same system.Intuitive Surgical If you have heard about robotic surgery for a different operation, it may not have been the same robot. For heart surgery today, the answer is usually the same one everywhere.
Your surgeon
Sameer Singh, MD. Attending surgeon, Section of Adult Cardiac Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center.
Dr. Singh trained in minimally invasive and robotic cardiac surgery, with particular expertise in robotic coronary revascularization and mitral valve surgery. He also performs traditional coronary bypass and cares for patients with advanced heart failure, including heart transplantation and mechanical circulatory support.Columbia Surgery
Milstein Hospital Building, 177 Fort Washington Avenue, New York, NY 10032.Columbia Surgery
Robotic coronary revascularization at NewYork-Presbyterian/Columbia
Robot-assisted LIMA-to-LAD grafting through a left minithoracotomy, multi-arterial robotic grafting for selected multivessel anatomy, and a hybrid revascularization pathway run jointly with interventional cardiology. Conventional CABG remains available for everyone else, from the same surgeon.
- Robot-assisted MIDCAB
- Robotic LIMA harvest on the da Vinci system, then a hand-sewn LIMA-LAD anastomosis through a small left anterior minithoracotomy, off pump, with a tissue stabilizer placed through the incision.Ann Cardiothorac Surg 2024
- Multi-arterial robotic grafting
- Bilateral internal mammary artery harvest for selected multivessel anatomy, sparing the sternum in patients where sternal healing is a concern.
- Hybrid coronary revascularization
- Robotic LIMA-LAD plus staged PCI to non-LAD targets, sequenced and signed off by surgeon and interventionalist together. The pathway.
- Conventional CABG and high-risk backup
- Sternotomy CABG for anatomy unsuited to a minimally invasive approach. The same surgeon covers advanced heart failure, mechanical circulatory support and transplantation, so patients with poor ventricular function are evaluated for the full range of options.Columbia Surgery
Sameer Singh, MD
Attending surgeon, Section of Adult Cardiac Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center. Instructor in Surgery.
Integrated cardiothoracic surgery residency at NewYork-Presbyterian/Columbia; MD through the Honors Program in Medical Education at Northwestern. Specialized training in minimally invasive and robotic cardiac surgery, with particular expertise in robotic coronary revascularization and mitral valve surgery. Early Investigator Presentation Award, International Society for Minimally Invasive Cardiothoracic Surgery, 2025.Columbia Surgery
Patient selection
Send anyone with a significant proximal LAD lesion who would rather avoid a sternotomy. Below is what the surgical review weighs. Borderline anatomy is worth a phone call before you decide it is unsuitable.
Good candidates
- Isolated LAD disease in a patient who needs a more durable solution than PCI, including younger patients.Columbia Surgery
- Multivessel disease suited to a hybrid strategy: an LAD lesion for the LIMA graft and non-LAD lesions with anatomy favorable for PCI, typically a low to intermediate SYNTAX score.J Clin Med 2025
- Multivessel disease with non-viable myocardium in the non-LAD territories, where the LIMA-LAD graft is the whole operation.Columbia Surgery
- Patients in whom sternal healing is a concern, for example chronic kidney disease, where a sternum-sparing approach avoids dehiscence risk and the LIMA-LAD is done off pump.J Clin Med 2025
What points toward conventional CABG
- Prior open heart surgery or unfavorable chest anatomy.Columbia Surgery
- Lung disease that would not tolerate single-lung ventilation, which the left thoracotomy approach requires.J Clin Med 2025
- Targets beyond the LAD that the minithoracotomy cannot reach and that are poor PCI targets.
- Hemodynamic instability or a need for emergency surgery.
Every robotic case is prepped and draped for conversion to sternotomy. Pooled conversion in published robot-assisted MIDCAB series is 3.2%, and one program that started in 2024 reported no conversions in its first 27 patients.Ann Thorac Surg Short Rep 2026
What the review needs
- Catheterization images as well as the report. Lesion location, LAD caliber and any intramyocardial course drive the decision.
- Echocardiogram, and a chest CT if one exists.
- Pulmonary function tests in anyone with known lung disease.
- Medication list with the timing of P2Y12 inhibitors and anticoagulants.
- History of chest surgery or chest radiation, and renal function.
Hybrid coronary revascularization, as a shared program
Hybrid coronary revascularization pairs a surgical LIMA-LAD graft with PCI to non-LAD lesions. The 2018 ESC/EACTS revascularization guideline gives hybrid procedures a Class IIb, level B recommendation: they "may be considered in specific patient subsets at experienced centres".J Clin Med 2025
Where interventional cardiology sits in it
The interventionalist chooses and treats the non-LAD targets, sets the antiplatelet plan, and sees the patient back in clinic. The surgeon contributes one graft, the LIMA to the LAD, without a sternotomy. The patient stays with the referring cardiologist for follow-up, and both services sign the plan.
How a hybrid case runs here
Cardiologist flags the case
After diagnostic catheterization, with the images available for surgical review.
Joint plan
Surgeon and interventionalist agree the targets, the sequence and the antiplatelet strategy, documented in one note.
Robotic LIMA-LAD
Off pump, through a left minithoracotomy, typically 2 to 4 days in hospital.Columbia Surgery
Staged PCI
To the non-LAD lesions, in the agreed window, with the LIMA graft imaged at the same sitting.
Follow-up returns to you
Discharge summary and operative note to the referring cardiologist, who manages the antiplatelet course.
Sequencing
- Surgery first
- Favored when the LAD is the culprit lesion in an acute coronary syndrome or a critical lesion with stable angina. One center performed 66% of its staged PCIs within 72 hours of the MIDCAB, with a range of 1 to 34 days.J Clin Med 2025
- PCI first
- When a non-LAD lesion needs treatment first; surgery then follows on antiplatelet therapy. A series of 115 PCI-first patients had a median interval of 100 days between stages.J Clin Med 2025
- Same session
- Possible in a hybrid operating room; most centers stage the two procedures.J Clin Med 2025
Evidence
- Against multivessel CABG in the short term: shorter hospital stay, fewer infections and fewer transfusions, with similar acute kidney injury, myocardial infarction and atrial fibrillation.J Clin Med 2025
- Two randomized trials: HYBRID (94 hybrid versus 97 CABG) found similar 5-year all-cause mortality, myocardial infarction, stroke and repeat revascularization; MERGING (40 versus 20) found no difference at 2 years.J Clin Med 2025
- Uptake is low nationally: 0.48% of CABG operations in the STS database from 2011 to 2013 were hybrid. The limiting factor is a working pathway between the cath lab and the operating room.J Clin Med 2025
Refer a patient
Sameer Singh, MD. Cardiac Surgery, Milstein Hospital Building, 177 Fort Washington Avenue, New York, NY 10032. Program line for the Robotic Cardiac Surgery Program: (212) 305-8312.Columbia Surgery
What to send
- Catheterization report and images, on disc or through an image-sharing link.
- Echocardiogram; chest CT if obtained.
- Pulmonary function tests in patients with lung disease.
- Medication list, including P2Y12 inhibitor and anticoagulant timing.
- Prior chest surgery or radiation, renal function, and the clinical question you want answered.
What comes back
- A written recommendation naming the operation: robotic MIDCAB, multi-arterial robotic grafting, hybrid revascularization, conventional CABG, or continued PCI and medical therapy, with the reasoning.
- For hybrid cases, a proposed sequence and antiplatelet plan for your sign-off.
- Operative note and discharge summary to you, and follow-up back in your clinic.
Patients who ask about the robot but need a sternotomy
Send them as well. Patients search for minimally invasive options and come to programs that offer them. A share of those patients are better served by conventional CABG, and the evaluation sorts that out, so offering the robotic option grows the whole coronary program, including the traditional operations.
Technology, and the road to totally endoscopic bypass
- Platform
- The da Vinci Xi system (Intuitive), in use across Columbia's robotic cardiac program.Columbia Surgery The robot harvests the internal mammary artery; the anastomosis is hand-sewn through the minithoracotomy.Ann Cardiothorac Surg 2024
- Beating-heart stabilization
- A suction tissue stabilizer, Medtronic's Octopus Nuvo in the published robot-assisted MIDCAB technique, holds the LAD still through the small incision so the bypass is done off pump.Ann Cardiothorac Surg 2024Medtronic
- The missing robotic stabilizer
- Intuitive's EndoWrist Stabilizer was available on the da Vinci Si and was discontinued on the Xi; its absence has been described as a critical barrier to broader adoption of robotic multi-arterial TECAB.Innovations 2025 Dr. Singh expects a robotic stabilizer for the current platform within the next one to two years, which would remove the main technical obstacle to totally endoscopic grafting.
- Totally endoscopic CABG (TECAB)
- Ports only, no thoracotomy, on the beating heart. The reference series is 874 patients at the University of Chicago from 2013 to 2024. Of those, 54% were multivessel, with one intraoperative conversion, a mean stay of 2.3 days, early LITA-LAD patency of 98%, and 45% done as hybrid procedures.JTCVS 2024 The program plans dedicated TECAB training at an outside high-volume center within one to two years, then a staged introduction, single-vessel first.
- Other instruments
- Companies other than Intuitive build the ancillary tools used alongside the robot: stabilizers and positioners for off-pump grafting, intracoronary shunts and soft-tissue retractors for the minithoracotomy.Ann Cardiothorac Surg 2024
In January 2002, Dr. Michael Argenziano and Dr. Craig Smith performed a robot-assisted coronary bypass at NewYork-Presbyterian without any chest incision, which CUIMC reported as the first in the United States.CUIMC news
Other companies building surgical robots, and why none reaches cardiac surgery yet
Surgical robotics is a crowded field, but cardiac surgery is not. Intuitive's da Vinci remains the only platform with FDA clearance for cardiac procedures;Intuitive Surgical every other major entrant is either pre-cardiac, cardiac-adjacent, or has exited cardiac work entirely.
| Company / platform | What it is, and cardiac relevance |
|---|---|
| Intuitive Surgical: da VinciSunnyvale, CA. Public, NASDAQ: ISRG | The platform in use here. FDA-cleared for cardiac procedures on January 26, 2026: mitral and tricuspid valve repair, internal mammary artery mobilization, PFO/ASD closure, left atrial appendage closure, atrial myxoma excision and epicardial lead placement. These clearances use non-force-feedback instruments. Full robotic anastomosis for TECAB is still performed under surgeon judgment and institutional protocol; it is not yet a dedicated FDA indication.Intuitive SurgicalMassDevice |
| Medtronic: Hugo RASDublin / Minneapolis. Public, NYSE: MDT | FDA-cleared December 3, 2025 for urology only; pending filings cover general and gynecologic surgery. No cardiac indication, trial or public roadmap as of this writing.Medtronic |
| Johnson & Johnson / Ethicon: OttavaNew Brunswick, NJ. Public, NYSE: JNJ | FDA authorization received July 22, 2026 for ten general and abdominal procedures, including gastric bypass and cholecystectomy. No cardiac indication.Johnson & Johnson |
| Siemens Healthineers: CorPathErlangen, Germany, via the Corindus acquisition | A different clinical pathway: a catheter-driven robot for percutaneous coronary intervention, not cardiac surgery. Siemens discontinued the cardiology line of the business in 2023 and now develops CorPath only for neurovascular procedures.MD+DI |
| Stereotaxis: Genesis / MAGiCSt. Louis, MO. Public, NYSE American: STXS | Robotic magnetic navigation for cardiac electrophysiology (arrhythmia ablation), not surgery. FDA-approved its MAGiC ablation catheter in January 2026, and acquired Robocath, a competing PCI-robot maker, in July 2026.Stereotaxis |
| Capstan MedicalSanta Cruz, CA. Private, backers include Intuitive Ventures | A dedicated robotic platform for transcatheter mitral and tricuspid valve replacement, delivered by catheter, not through an incision. First-in-human cases in March 2025. A structural-heart specialty that treats valve disease, separate from surgical CABG.MassDevice |
- If a patient or a colleague asks whether "the robot" matters, the question is which company's robot, since only one is cleared for cardiac work today.
- Catheter-driven PCI robots (CorPath) treat coronary artery disease through an endovascular route instead of surgical bypass grafting. Electrophysiology robots (Stereotaxis) and structural-heart platforms (Capstan) treat different anatomical targets: arrhythmia pathways and heart valves. Neither replaces surgical revascularization.
- The cardiac clearance is new, from January 2026. A program citing it should say so plainly, not imply a mature, high-volume category.MedTech Dive
The regional landscape, and where Columbia stands
New York State reports every isolated CABG and PCI by hospital. Robotic and hybrid cases are not broken out, so the market is read from the whole coronary population and the LAD-dominant subset within it.
Programs that publish robotic coronary work in New York and New Jersey
| Program | What they publish |
|---|---|
| NYP/ColumbiaManhattan. This program. | Robot-assisted MIDCAB, multi-arterial robotic grafting, hybrid revascularization; robotic cardiac program since 2023, 300+ robotic heart operations.Columbia Surgery |
| NYU Langone HealthManhattan | Robotic-assisted CABG for single-vessel disease, hybrid procedures with interventional cardiology, typical stay 1 to 3 days; more than 1,200 robotic cardiac procedures overall.NYU LangoneNYU Langone |
| NYP/Weill CornellManhattan | Totally endoscopic robotic CABG expertise; minimally invasive CABG through a 2 to 3 inch incision with a heart stabilizer developed by its surgeons.NYP |
| Mount Sinai MorningsideManhattan, formerly Mount Sinai St. Luke's | First TECAB cases in the health system reported in June 2019.Mount Sinai |
| Northwell, South Shore University HospitalBay Shore, Long Island | Robot-assisted MIDCAB program started July 2024; first 27 patients published with a mean stay of 3.9 days and no conversions.Ann Thorac Surg Short Rep 2026 |
| Hackensack University Medical CenterHackensack, New Jersey | Robotic cardiac program including CABG; describes itself as performing the most robotic cardiac surgeries in New Jersey.Hackensack Meridian |
| Jersey Shore University Medical CenterNeptune, New Jersey | First robotic-assisted CABG in August 2017 on the da Vinci Xi, through three small incisions.Newswise 2017 |
| University of Chicago MedicineChicago. Reference program for TECAB. | More than 2,000 robotic TECAB procedures; the largest published series, 874 patients with up to 10-year follow-up.UChicago MedicineJTCVS 2024 |
Columbia's position
- The city's highest-volume CABG service and a 2,000-plus-case PCI service in the same building, which is the precondition for a hybrid program.NYS DOH
- A robotic cardiac program with an operating-room team already trained across 300 mitral and other robotic cases.Columbia Surgery
- Backup for the highest-risk coronary patients: conventional CABG, mechanical circulatory support and transplantation under the same surgeon.Columbia Surgery
- In January 2002 this campus performed a closed-chest robot-assisted bypass that CUIMC reported as the first in the United States.CUIMC news
Priorities for the next two years
- Build referral volume with interventional cardiology through the hybrid pathway.
- Make robot-assisted MIDCAB reproducible: one protocol, every case, outcomes tracked and published.
- Reach patients who search for minimally invasive options, and route the ones who need a sternotomy to conventional CABG on the same service.
- Train for TECAB at an outside high-volume center, then introduce it in stages.
- Learn from and collaborate with established programs; the published advice for new programs is structured training supported by an experienced robotic surgeon.Ann Thorac Surg Short Rep 2026
What makes a program worth partnering with
- Published outcomes with numbers: conversion rate, graft patency, length of stay.
- A structured training pathway and willingness to proctor early cases.
- Shared protocols for the hybrid sequence and antiplatelet management.